If possible, we would like to text you with occasional reminders and pertinent updates.

Mailing Address Line 1

Include apartment, suite or box number, if applicable.

Mailing Address Line 2

City

State

Zip Code

Email Address

We recommend an email address unique to the registered volunteer instead of a shared office address or the personal address of a group leader for all group members. We will send personalized scheduling correspondence to this address.

Confirm Email Address

User Name

Establish your unique User Name. You may use your email address as your User Name unless another registered volunteer will be receiving correspondence at that same address.

Password

Used to recall your information when you visit this site again so you can make changes and/or select additional volunteer opportunities. Your password must be at least 6 characters.

Confirm Password

Required Age

Yes

I will be at least 14 years of age when I volunteer. Volunteers under 18 must email volunteers@ramusa.org for the RAM Minor Release Form.

For legal reasons these are the age restrictions for volunteering.

Demographics and Background

T-Shirt Size

T-Shirt style is adult unisex.

Language Fluency (other than English)Select all that apply

Hold down the control key to select more than one language.
Hold down the control key and click on a selected language to de-select it.

Other Information

Yes

No

Do you have a CDL Truck Driver's License?

Yes

No

Pilot's License, Certifications, and Experience

Please list any flight certifications, as well as hours/experience in each type of aircraft you are able to fly. Optional, indicate any aircraft you own. Additionally, please include any aircraft you own and would be willing to fly for RAM.

Yes

No

Blood Borne Pathogen Certified

Have you taken an infection control/ blood-borne pathogen certification training?

Yes

No

Vaccinated for Hepatitis B

Yes

No

Interested in deploying for disaster relief missions?

Check this box if you would like to receive more information in the event that RAM needs people to deploy for a disaster.

Yes

No

Interested in volunteering for international clinics?

If you are interested in doing medical clinics in other countries, please check this box and include any relevant information in the box below.

Yes

No

Interested in traveling within the United States for clinics?

If you are willing to travel to clinics further away from you but still within the United States please check this box.

Company / Organization

Optional, but helpful to know especially if you're coming with an office or team.

Matching

Yes

My company has a matching program

Please indicate if your employer matches your donated time with a financial donation to the non-profit where you volunteer.

Matching Program Details

Description

Describe the program requirements and let us know how we can help - provide information for anyone we must contact and/or list any documentation you might need etc.

Emergency Contact

First and Last Name

Relationship

Phone

Profession or Volunteer Classification

Event Area

Select the area appropriate to your profession / classification.

Profession / Classification

General Notes
(if needed)

I am currently in a residency program.

I am a healthcare student.

License Number

Enter "none" if a license is optional for your profession and you do not have a license. Set the Expiration Date in the future.

Expiration Date

Prof. Liability Insurance Carrier

Professional malpractice insurance is your responsibility. Write "NONE" if you do not have any and reach out to RAM to learn more about being added to our insurance plan.

State of Licensure

Out-of-state providers MUST follow the procedures for out of state volunteers.

Only U.S. licensed professionals are able to volunteer as healthcare providers.

License Comment

List additional information we should know. Examples: You selected Other Professional - indicate field/specialty. Your license will renew before the clinic. You are licensed in a second field - provide license details.

Residency Details

Residency Location

Residency Supervisor

Student Details

We welcome student participation at our clinics! We have three main types of student participation:

Pre-Health: If you are in a pre-healthcare track (pre-med, pre-nursing, pre-dentistry, etc.), please select "General Support" as your assignment. Since you are not a licensed medical professional, we could use your help as a General Support volunteer where your tasks may range from helping in patient registration to dental sterilization, depending on your interests and our needs at the clinic. We are excited for your to get some volunteer experience with us!

In Professional School - No Supervisor Present: If you are in medical, nursing, dental, etc. school yet you do not have a licensed faculty supervisor accompanying you to the clinic, you will not be able to practice patient care at the RAM clinic. This means you will not be able to provide any medical services or treatments to our patients. You are welcome to sign up for your respective field's "Support" category. (i.e. Dental Support, Vision Support, Medical Support). This will allow you to assist the professionals in that clinic area by helping with patient flow, serving as a scribe to the licensed professional, etc. This is a great opportunity for your to gain shadowing experience or talk to professionals in the field you are studying while also helping the RAM clinic to run smoothly. Please fill out your school's information below.

In Professional School - Supervisor Present: If you are in medical, nursing, dental, etc. school and you do have a licensed faculty supervisor that will accompany you to the clinic and if you are at least over halfway finished with your program and well into clinical rotations, then you will be able to practice patient care under your faculty's supervision. However, that supervisor must contact us at: volunteers@ramusa.org This is how our Volunteer Coordinators will provide the correct information, discuss the requirements, and approve your school for a specific clinic. Once you have been approved, you will be able to select a student assignment that will show up as your student type and your university ("Nursing Student - University of Tennessee"). Please fill out your school's information below.

Events

THEN, click the RECALL button at the top to pull up your record, scroll down, and pick your assignments for the second event (and repeat).

Event Location

---

More detailed directions will be available prior to your arrival.

Event Email

---

Please add this information to your safe senders/callers list.

Event Phone

---

Event Information

Please select an assignment for each day you plan to attend.

- Waiting Lists: if your preferred assignment is full, a waiting list option may be shown. If you choose to be on the waiting list for your preferred assignment, you will also be given the option to select an alternate assignment. If an opening becomes available in your preferred assignment, you will receive an email notice (and, if selected, a text message) automatically moving you to your preferred assignment. This will automatically cancel you from the alternate assignment.

Admin Code

For administrative or instructed use only.

Day

Type

Assignment

Assignment Specific Questions (If Any)

Optional Profile Picture

Select your profile picture

You may optionally upload a profile image. Just skip this option if you do not care to share an image. We accept GIF, JPG, and PNG images.

Your current picture

Upload Volunteer Documents (if needed for your assignments)

If you have been directed to upload a document of some kind please do so below. This is otherwise not necessary.

Document 1 Name

Document 2 Name

Document 3 Name

No files have been uploaded

Liability Waiver

Remote Area Medical thanks you for volunteering. Each volunteer is required to read and sign this Volunteer Agreement and Liability Waiver as a condition of participating in the event.

CONFIDENTIALITY STATEMENT

I understand that while I am participating as a registered volunteer at the Remote Area Medical clinic, it is mandatory that I maintain complete privacy and confidentiality of all patients. This pertains to all present and future written and verbal communications referring to any Remote Area Medical clinic patient. I also understand that unless I am obtaining information strictly for patient registration, I DO NOT ASK a patient any questions regarding medical insurance coverage, Medicare, or Medicaid. With my signature on the line below, I acknowledge that I have read, understand, and agree to adhere to this policy of confidentiality for the Remote Area Medical clinic.

RELEASE AND INDEMNIFICATION

I hereby release and indemnify Remote Area Medical, a non-profit organization, and all its respective officers, directors, agents, contractors, heirs, successors, and assigns, from prosecution or presentation of any claim for bodily injury or death or for property loss or damage incurred in connection with this Remote Area Medical expedition or related activities. I fully understand that I am volunteering at my own risk and that due to my occupational/other possible exposure to blood or other potentially infectious materials, I may be at risk of acquiring Hepatitis B virus (HBV) infection or other blood borne pathogens. I understand if I do not have the HBV vaccine, I continue to be at risk for acquiring HBV, a serious disease. If, in the future, I want to be vaccinated with HBV vaccine, I can acquire the vaccination at my own expense.

MEDIA DISCLAIMER

I give my permission for Remote Area Medical, its employees, agents and subcontractors, to use my likeness captured in any photographs, videotape or other similar product by means of camera or any electronic or other similar devices, to be used for any purpose whether or not published and whether or not I am aware of the fact that my likeness has been captured.

Sign in the space below:

Please use your mouse to sign on a PC or use your mobile device touch screen

Save and Submit - To Generate Confirmation

Thank you for registering as a volunteer.
Upon clicking the SAVE AND SUBMIT button, you will be emailed a confirmation of your registration/updates.

Software built by
The SPARK Team, LLCContact us to find out more about Spark volunteer systems.Your organization can be registering volunteers with this software at your next event!